Fig. 11.1
Fundus photograph montage of a patient with pigmentary retinopathy secondary to congenital rubella syndrome
Acquired rubella manifests as a maculopapular rash and mild systemic symptoms including fever and lymphadenopathy. The incubation period for the virus is 14–18 days, and infected individuals may shed virus and are potentially contagious for 1–2 weeks before the onset of classic symptoms. Arthritis and arthralgias occur in approximately 70 % of teenagers and adult females; this complication rarely develops in children and adult males [1]. The most common ocular manifestation is conjunctivitis which is present in 70 % of patients. Other ocular sequelae include epithelial keratitis and retinitis. There has been growing evidence to support a causal association with chronic rubella virus infection and Fuchs heterochromic iridocyclitis. This has been proposed due to the presence of rubella-specific intraocular antibody production in the anterior chamber of patients with Fuchs [6].
Diagnosis
The diagnosis of congenital rubella is established via the presence of maternal rubella infection and congenital anomalies. Serologic data can confirm the diagnosis via the detection of rubella-specific IgM antibodies in the infant or cord blood. The diagnosis of acquired rubella can be established by a fourfold increase in rubella-specific IgG titers obtained 1–2 weeks apart or the new appearance of rubella-specific IgM.
Treatment
Treatment for those afflicted with rubella virus is typically supportive care: there is no specific therapy. For women in the first 20 weeks of pregnancy with exposure to the virus, immune globulin may be administered to prevent both maternal and fetal infection. For those with acquired rubella, no treatment is indicated for the conjunctivitis or keratitis as these are self-limited. The uncommon manifestation of rubella retinitis responds well to systemic steroids. The treatment for Fuchs heterochromic iridocyclitis is detailed in the respective chapter of this text.